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One size doesn’t fit all for newborn babies, study finds

Small babies may be misclassified as small for gestational age

To be considered underweight, a Caucasian baby would have to weigh less than around 5.5 lb. Ella Grace Almeida, who was photographed at B.C. Women’s Hospital in 2007 when the results of the original study were released, weighed 9 lbs, 10 oz. She was 52 cm long with a head circumference of 37.5 cm.

Photograph by: ian lindsay
, Vancouver Sun

The “one size fits all” charts used in hospitals to measure newborn weights aren’t necessarily helpful in predicting whether babies of certain ethnicities are truly undersized, a new study shows.

A pair of B.C. researchers used data on more than 100,000 Washington State newborns to verify the theory that there are often size differences between Caucasian, East Asian and South Asian babies. But newborn charts are based on Caucasian norms.

The study, published online in the American Journal of Obstetrics & Gynecology, says when ethnicity is not taken into account, a considerable number of babies may be misclassified as small for gestational age (SGA).

Such babies would then be more closely monitored after birth, insulated with infection control measures and provided with more nutrients. Infants deemed to be too small are more likely to be admitted to neonatal intensive care units, to being placed on ventilators and staying longer in hospital.

“We found a considerable number of babies classified as small for gestational age by the conventional birth weight chart were actually healthy babies,” said Gillian Hanley, who co-authored the study with Patricia Janssen. Both are affiliated with UBC and the Child and Family Research Institute. “This leads to parental anxiety, unnecessary testing and increased health care costs,” Hanley said.

Having a more accurate way to identify SGA infants who are truly at risk for problems minimizes medical interventions, saves hospital costs and avoids anxiety on the part of parents, the authors say.

Six years ago, researchers from the University of B.C., the Child and Family Research Institute and Women’s and Children’s hospitals published a first-of-its-kind study on nearly 2,700 infants born at BC Women’s Hospital. That was the first to show that ethnicity is a more accurate way of identifying newborns at risk for complications stemming from low birth weights, rather than relying on Caucasian norms.

Half of all babies delivered at BC Women’s Hospital are of East Asian or South Asian descent. Experts are wary of labelling as malnourished or undersized babies who are small, relative to Caucasian standards. The latter are often six- to eight-per-cent heavier because of body weight, head circumference and length.

In the new study utilizing Washington state data, Hanley and Janssen prove the same hypothesis, except this time on a much grander scale.

Starting with a sample of nearly 200,000 child-bearing women (over a two-year period), the authors narrowed the study pool down to 6,774 small-for-gestational-age infants, after excluding thousands who were pre- or post-term, multiples and others. This group of nearly 7,000 was considered small by standard measurements, but the charts taking ethnicity into account identified far fewer (2,277) SGA infants.

Although Washington state has a more diverse population, including many African-Americans, the B.C. researchers used only Caucasian, Chinese and South Asian babies in the Washington study, since that’s the mix they had previously studied in B.C. and for which they had developed ethnic size charts.

Ethnic-specific birth weight charts are better at predicting which infants require close monitoring, “largely by identifying the babies at the more severe end of the small for gestational age spectrum in each ethnic group” said Hanley.

Although the charts were first developed in 2007, they still aren’t being used in B.C. But Hanley said she’s hoping that will change, now that the even larger Washington study has been published, showing that the ethnic charts are reliable and unlikely to miss detecting babies that will have health problems because of their smaller size.

To be considered underweight, a Caucasian baby would have to weigh less than around 5.5 lb. Ella Grace Almeida, who was photographed at B.C. Women’s Hospital in 2007 when the results of the original study were released, weighed 9 lbs, 10 oz. She was 52 cm long with a head circumference of 37.5 cm.

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